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Background and Aims Point of care ultrasonography has increasingly become a diagnostic tool in managing critical ill patients.Gastric ultrasound of the antrum can form part of the quantification of gastric size and content and the subsequent planning of treatment, in a context where delayed gastric emptying is a common complication.

Methods We present three cases of severe gastroparesis revealed through routine G-POCUS in the ICU.

Results Case 1:38-year old male patient on the fourth postoperative day after Sugar Baker surgery. Routine G-POCUS revealed a severely dilated gastric antrum.Prokinetics were initiated.Case 2:50-year old male patient with multiple myeloma on the 5th line of treatment,admitted in the ICU due to cytokine release syndrome with the possibility of co-infection.Due to deterioration of the level of consciousness an MRI was scheduled.The patient was on total parenteric nutrition,without oral intake for the previous 7 days. Routine G-POCUS revealed severe gastroparesis and solid gastric content within.Nasogastric tube was inserted and a triple therapy with prokinetics was initiated.The imaging was reprogrammed.Case 3:70-year old male patient admitted in the ICU with septic shock of abdominal origin.Nasogastric tube was in place.Routine G-POCUS revealed severe dilation of gastric antrum,a fact that led to prokinetic escalation and an increase in the frequency of aspiration through the nasogastric tube.

Conclusions In all three cases no aspiration was documented.Although POCUS accuracy can be operator-dependent, the findings, when integrated in stepwise protocols and correlated with the clinical context can be used to guide treatment.Future research will determine whether POCUS can become an extension of physical examination regarding diagnosis and problem-solving.